<%@ Control Language="VB" AutoEventWireup="false" CodeFile="Referral.ascx.vb" Inherits="WebForms_Referral" %>
<%@ Register Assembly="AjaxControlToolkit" Namespace="AjaxControlToolkit" TagPrefix="ajaxToolkit" %>

<div id="divMain" runat="server">
    <table border="0" cellpadding="0" cellspacing="0" width="800">
        <tr><td style="font-size: 3px;height: 5px;"></td></tr>
    </table>

    <table border="0" cellpadding="0" cellspacing="0" width="800">
        <tr>
        <td id="name_td" runat="server" align="left" style="font-weight: bold; font-size: 10pt; font-family: Arial;">
        </td>
        <td></td>
        </tr>
        <tr>
        <td id="policy_td" runat="server" align="left" style="font-weight: bold; font-size: 10pt; font-family: Arial;">
            &nbsp;</td>
        <td></td>
        </tr>
        <tr>
        <td id="provider_td" runat="server" align="left" style="font-weight: bold; font-size: 10pt; font-family: Arial;">
        </td>
        <td align="right" style="font-weight: bold; font-size: 10pt; font-family: Arial; color: #d63007;">
            Add New Referral</td>
        </tr>
    </table>

    <table border="0" cellpadding="0" cellspacing="0" width="800">
        <tr><td style="font-size: 3px; background-color: #105BA4; height: 3px;"></td></tr>
    </table>

    <br />

    <table border="0" cellpadding="0" cellspacing="0" width="800" style="background-color: #f2f3f5">
    
    <tr><td style="width: 800px">
        
        <table border="0" cellpadding="0" cellspacing="0" width="100%">
        <tr>
            <td style="font-size: 10pt; font-family: Verdana; width: 120px; height: 28px;" align="left">
                &nbsp;Referral Name:</td>
            <td style="width: 680px; height: 28px;" align="left">
                <asp:TextBox ID="LastName_txt" runat="server" Width="216px" TargetControlID="LastName_txt"></asp:TextBox>
                <asp:TextBox ID="FirstName_txt" runat="server" Width="216px">
                </asp:TextBox>
                <asp:TextBox ID="MiddleName_txt" runat="server" Width="152px"></asp:TextBox>
            </td>
        </tr>
        </table>
            
    </td></tr>
        
    <tr><td style="width: 800px">

        <table border="0" cellpadding="0" cellspacing="0" width="800" style="height: 35px">
            
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 120px;" align="left">
                    &nbsp;Advisor:</td>
                <td style="width: 280px" align="left">
                    <asp:DropDownList ID="Advisor_ddl" runat="server" Width="184px">
                </asp:DropDownList></td>
                <td style="font-size: 10pt; font-family: Verdana; width: 130px;" align="left">
                    &nbsp;Referral Status:</td>
                <td align="left" style="width: 270px">
                    <asp:DropDownList ID="Status_ddl" runat="server" Width="184px">
                </asp:DropDownList></td>
            </tr>
        </table>
            
    </td></tr>
    
    <tr><td style="width: 800px; height: 40px;">

        <table border="0" cellpadding="0" cellspacing="0" width="800" style="height: 32px">
            <tr>
                <td style="font-size: 10pt; font-family: Verdana; width: 120px;" align="left">
                    &nbsp;Remarks:</td>
                <td style="width: 680px" align="left">
                    <asp:TextBox ID="Remarks_txt" runat="server" TextMode="MultiLine" Width="584px"></asp:TextBox></td>
            </tr>
        </table>
            
    </td></tr>

    <tr><td style="width: 800px; height: 40px;">

        <table border="0" cellpadding="0" cellspacing="0" width="800" style="height: 32px">
            <tr>
                <td style="width: 400px; height: 24px;"></td>
                <td style="height: 24px">
                    <asp:Button ID="Save_btn" runat="server" Text="Save" BackColor="Gainsboro" Font-Names="Verdana" Width="104px" />
                </td>
                <td style="height: 24px">
                    <asp:Button ID="Cancel_btn" runat="server" Text="Back" BackColor="Gainsboro" Font-Names="Verdana" Width="112px" CausesValidation="False" />
                </td>
            </tr>
        </table>
            
    </td></tr>

    </table>
</div>
<ajaxToolkit:TextBoxWatermarkExtender ID="TextBoxWatermarkExtender3" runat="server"
    TargetControlID="LastName_txt" WatermarkCssClass="WaterMk" WatermarkText="Last Name">
</ajaxToolkit:TextBoxWatermarkExtender>
<ajaxToolkit:TextBoxWatermarkExtender ID="TextBoxWatermarkExtender4" runat="server"
    TargetControlID="FirstName_txt" WatermarkCssClass="WaterMk" WatermarkText="First Name">
</ajaxToolkit:TextBoxWatermarkExtender>
<ajaxToolkit:TextBoxWatermarkExtender ID="TextBoxWatermarkExtender5" runat="server"
    TargetControlID="MiddleName_txt" WatermarkCssClass="WaterMk" WatermarkText="Middle Name">
</ajaxToolkit:TextBoxWatermarkExtender>
<br />
<asp:RequiredFieldValidator ID="rfv1" runat="server" ControlToValidate="LastName_txt"
    ErrorMessage="Last Name Required" ForeColor="White" Text="."></asp:RequiredFieldValidator><asp:RequiredFieldValidator
        ID="rfv2" runat="server" ControlToValidate="FirstName_txt" ErrorMessage="First Name Required"
        ForeColor="White" Text="."></asp:RequiredFieldValidator><asp:RequiredFieldValidator
            ID="rfv3" runat="server" ControlToValidate="Advisor_ddl" ErrorMessage="Advisor Required"
            ForeColor="White" Text="."></asp:RequiredFieldValidator><asp:RequiredFieldValidator
                ID="rfv4" runat="server" ControlToValidate="Status_ddl" ErrorMessage="Referral Status Required"
                ForeColor="White" Text="."></asp:RequiredFieldValidator><asp:ValidationSummary ID="ValidationSummary1"
                    runat="server" ShowMessageBox="True" ShowSummary="False" />
<ajaxToolkit:ValidatorCalloutExtender ID="ValidatorCalloutExtender1" runat="server"
    TargetControlID="rfv1">
</ajaxToolkit:ValidatorCalloutExtender>
<ajaxToolkit:ValidatorCalloutExtender ID="ValidatorCalloutExtender2" runat="server"
    TargetControlID="rfv2">
</ajaxToolkit:ValidatorCalloutExtender>
<ajaxToolkit:ValidatorCalloutExtender ID="ValidatorCalloutExtender3" runat="server"
    TargetControlID="rfv3">
</ajaxToolkit:ValidatorCalloutExtender>
<ajaxToolkit:ValidatorCalloutExtender ID="ValidatorCalloutExtender4" runat="server"
    TargetControlID="rfv4">
</ajaxToolkit:ValidatorCalloutExtender>
